Presentation on theme: "Care of Patients with Cardiac Problems"— Presentation transcript:
1 Care of Patients with Cardiac Problems Chapter 37Care of Patients with Cardiac Problems
2 Heart FailureAlso called pump failure, general term for the inability of the heart to work effectively as a pumpLeft-sided heart failureRight-sided heart failureHigh-output failure
3 Left-Sided Heart Failure Typical causes—hypertensive, coronary artery, valvular diseaseFormerly known as congestive heart failureTwo types of left-sided heart failure:Systolic heart failureDiastolic heart failure
4 Right-Sided Heart Failure Typical causes—left ventricular failure, right ventricular MI, pulmonary hypertensionRight ventricle not able to empty completelyIncreased volume and pressure in the venous system and peripheral edema
5 High-Output Failure Cardiac output remains normal or above normal Caused by increased metabolic needs of hyperkinetic conditions such as:SepticemiaAnemiaHyperthyroidism
6 Compensatory Mechanisms Sympathetic nervous system stimulationRenin-angiotensin system (RAS) activationOther chemical responses:B-type natriuretic peptide (BNP)Myocardial hypertrophy
7 EtiologyHeart failure is caused by systemic hypertension in 75% of cases.About one third of patients experiencing myocardial infarction also develop heart failure.Structural heart changes, such as valvular dysfunction, cause pressure or volume overload on the heart.
10 Right-Sided Heart Failure Manifestations include:Distended neck veins, increased abdominal girthHepatomegaly (liver engorgement)Hepatojugular refluxAscitesDependent edemaWeight—the most reliable indicator of fluid gain or loss
19 Activity Intolerance Interventions include: Balance activity and rest. Nap to restore energy.Recognize energy limitations.Conserve energy.Adapt lifestyle to energy level.Report adequate endurance for activity.
20 Potential for Pulmonary Edema Interventions include:Assess for early signs, such as crackles in the lung bases, dyspnea at rest, disorientation, and confusion.High-Fowler’sOxygen therapyNitroglycerine, rapid-acting diuretics, IV morphine sulfateContinual assessment
21 Community-Based Care Home care management Health teaching Health care resources
24 AssessmentPatient may become suddenly ill or slowly develop symptoms over many years.Question patient about attacks of rheumatic fever and infective endocarditis and about possibility of IV drug abuse.Obtain chest x-ray, echocardiogram, and exercise tolerance test.
25 Common Nursing Diagnoses Decreased Cardiac Output related to altered stroke volumeImpaired Gas Exchange related to ventilation perfusion imbalanceActivity Intolerance related to inability of the heart to meet metabolic demands during activityAcute Pain related to physiologic injury agent (hypoxia)
26 Nonsurgical Management Nonsurgical management focuses on drug therapy and restDrug therapy, including diuretics, beta blockers, digoxin, oxygen, and sometimes nitratesProphylactic antibioticManagement of atrial fibrillationAnticoagulantRest with limited activity
29 Community-Based Care Home care management Health teaching Health care resources
30 Infective Endocarditis Microbial infection involving the endocardiumOccurs primarily in patients who abuse IV drugs, have had valve replacements, have experienced systemic infections, or have structural cardiac defectsPossible ports of entry—oral cavity, skin rash, lesion, abscess, infections, surgery, or invasive procedures including IV line placement
32 Diagnostic Assessment Blood cultureEchocardiographyThe most reliable criteria for diagnosing endocarditis include positive blood cultures, a new regurgitant murmur, and evidence of endocardial involvement by echocardiography
33 Interventions Antimicrobials. Anticoagulants are of no value in preventing embolization from vegetations.Patient’s activities are balanced with adequate rest.
34 Surgical Management Removing the infected valve Repairing or removing congenital shuntsRepairing injured valves and chordae tendineaeDraining abscesses in the heart or elsewhere
35 PericarditisInflammation or alteration of the pericardium, the membranous sac that encloses the heartDressler’s syndromePost-pericardiotomy syndromeChronic constrictive pericarditis
37 AssessmentSubsternal precordial pain radiating to left side of the neck, shoulder, or backGrating, oppressive pain, aggravated by breathing, coughing, swallowingPain worsened by the supine position; relieved when the patient sits up and leans forwardPericardial friction rub
43 Rheumatic CarditisSensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic streptococciInflammation in all layers of the heartFormation of Aschoff bodies, small nodules in the myocardium that are replaced by scar tissueImpaired contractile function of the myocardium, thickening of the pericardium, and valvular damage
44 Clinical Manifestations TachycardiaCardiomegalyNew or changed murmurPericardial friction rubPrecordial painChanges in electrocardiogramIndications of heart failureExisting streptococcal infection
45 Cardiomyopathy Subacute or chronic disease of cardiac muscle Dilated cardiomyopathyHypertrophic cardiomyopathyRestrictive cardiomyopathyArrhythmogenic right ventricular cardiomyopathy